Factors affecting influential discussions among physicians: a social network analysis of a primary care practice

Abstract

Background: Physicians often rely on colleagues for new information and advice about the care of their patients.

Objective: Evaluate the network of influential discussions among primary care physicians in a hospital-based academic practice.

Design: Survey of physicians about influential discussions with their colleagues regarding women's health issues. We used social network analysis to describe the network of discussions and examined factors predictive of a physician's location in the network.

Subjects: All 38 primary care physicians in a hospital-based academic practice.

Measurements: Location of physician within the influential discussion network and relationship with other physicians in the network.

Results: Of 33 responding physicians (response rate = 87%), the 5 reporting expertise in women's health were more likely than others to be cited as sources of influential information (odds ratio [OR] 6.81, 95% Bayesian confidence interval [CI] 2.25-23.81). Physicians caring for more women were also more often cited (OR 1.03, 95% CI 1.01-1.05 for a 1 percentage-point increase in the proportion of women patients). Influential discussions were more frequent among physicians practicing in the same clinic within the practice than among those in different clinics (OR 5.03, 95% CI 3.10-8.33) and with physicians having more weekly clinical sessions (OR 1.33, 95% CI 1.15 to 1.54 for each additional session).

Conclusions: In the primary care practice studied, physicians obtained information from colleagues with greater expertise and experience as well as colleagues who were accessible based on location and schedule. It may be possible to organize practices to promote more rapid dissemination of high-quality evidence-based medicine.

Figure 1

Network of influence among primary care physicians in a hospital practice. Points represent physicians, identified using arbitrary identification numbers. An arrow from 1 physician to another indicates that the first cited the second as someone with whom they had influential discussions about women’s health. Thin lines indicate relationships involving 1–3 influential discussions, thick lines 4 or more discussions. “E” before an identification number indicates that the physician is a self-identified women’s health expert. Circles denote female physicians, squares male physicians. Size of plot symbols corresponds to the percentage of women patients in a physician’s panel. Colors distinguish 4 physically separate clinics within the hospital; physicians designated with green points are part of the hospital’s women’s health clinic.